US20120116271A1 - Cellulite treatment - Google Patents

Abstract

A method and apparatus are provided for treating connective tissue. The method and apparatus can be used for treating and/or reducing the appearance of cellulite.

Description

• The present application claims priority as a continuation-in-part to U.S. patent application Ser. No. 12/842,734, entitled “Method for Improvement of Cellulite Appearance” and filed Jul. 23, 2010, which claims priority to U.S. Patent Application Ser. No. 61/271,593, filed on Jul. 23, 2009 which are herein incorporated by reference in their entireties. This application also claims priority to U.S. Patent Application Ser. No. 61/422,652, filed on Dec. 13, 2010, which is herein incorporated by reference in its entirety.
BACKGROUND OF THE INVENTION
• The appearance of cellulite on a person's body can create a perception that the person is unfit and/or overweight. Individuals, generally women who have cellulite, often view it as unflattering and as a source of embarrassment. It is desirable to improve and/or eliminate the appearance of cellulite in one or more locations of a subject's body. It is most desirable to achieve a long term and/or durable improvement and/or to eliminate the appearance of cellulite in treated regions.
SUMMARY OF THE INVENTION
• In accordance with the methods and devices disclosed herein the invention generally relates to the treatment of connective tissue in a subject's body to improve the appearance of cellulite on a subject's body. In some embodiments, the methods and devices treat connective tissue with substantially lasting, durable and/or irreversible results. Long lasting, durable and/or irreversible treatment of connective tissue can improve the appearance of cellulite for a relatively long period of time and/or substantially permanently.
• In one aspect, the invention relates to a method for improving the appearance of cellulite that comprises heating a portion of connective tissue to a temperature of at least about 50° C., and applying a tensile force to the heated connective tissue. In various aspects, the tensile force per unit area is greater than about 0.1 N/cm². In some aspects, the tensile force per unit area is greater than about 1 N/cm². In some aspects, the tensile force is sufficient to stretch the connective tissue. In some embodiments, the tensile force is sufficient to break the connective tissue. In various embodiments, the tensile force per unit area is insufficient to cause bruising of the skin.
• Heating the connective tissue can be performed invasively or non-invasively in a variety of manners. For example, in various embodiments, the heating step can comprise applying energy to the portion of connective tissue through a skin surface. In a related aspect, the heating step can comprise applying at least one of optical energy, electrical energy, RF energy, and ultrasound energy to the connective tissue. In some embodiments, the heating step comprises applying optical energy having at least one wavelength in a range of about 600 nm to about 2700 nm to the connective tissue. For example, the optical energy can have at least one wavelength in a range of about 910 nm to about 930 nm (e.g., about 915 nm). In a related aspect, the optical energy can comprise a plurality of pulses, for example, pulses having a pulsewidth in a range of about 0.1 second to about 10 seconds. The optical energy can be produced by a variety of sources, for example, coherent sources such as a laser or laser diode or incoherent sources such as a lamp.
• In one aspect, the heating step can comprise delivering a treatment tip through a skin surface to a location adjacent one or more septa. The treatment tip can be configured to deliver at least one of optical energy, electrical energy, RF energy, and ultrasound energy to the septa. By way of example, the heating step can comprise applying optical energy having at least one wavelength in a range of about 600 nm to about 2700 nm to the connective tissue, for example, at least one wavelength in a range of about 910 nm to about 930 nm (e.g., about 915 nm). In some aspects, the optical energy can comprise a plurality of pulses having, for example, a pulsewidth in a range of about 0.1 second to about 10 seconds.
• In various embodiments, the connective tissue can comprise one or more septa. The tensile force can be sufficient to break at least a portion of said one or more septa in said heated connective tissue. In some embodiments, the connective tissue can comprise one or more septa comprising collagenous fibers and blood vessels associated therewith, wherein the tensile force is sufficient to break at least one or more collagenous fibers within the one or more septa.
• In one aspect, the tensile force can be exerted on the connective tissue by applying suction to a skin surface. By way of example, applying suction to the skin surface can comprise disposing near the skin surface an element having a cavity formed therein for receiving a portion of skin tissue, said element having one or more passageways for applying an evacuative force to the cavity.
• In various embodiments, the tensile force can be applied to the connective tissue at least one of during and after said heating step. In some embodiments, the target can comprise. In one aspect, the portion of connective tissue can be heated to a temperature in a range of about 50° C. to about 100° C. By way of example, the portion of connective tissue can be heated to a temperature in a range of about 50° C. to about 70° C.
• In one aspect, the invention relates to a method for improving the appearance of cellulite. The method comprises positioning an element having a cavity formed therein adjacent skin tissue having a cellulite-mediated dimple, said element having one or more passageways for applying an evacuative force to the cavity. The method can also comprise activating a vacuum source so as to apply the evacuative force to draw a portion of the skin tissue into the cavity, the suction being effective to apply a tensile force to one or more septa within the skin. The method can also comprise heating a portion of the skin tissue to a temperature of at least about 50° C.
• In various embodiments, the method can comprise inserting a treatment tip into the skin tissue and positioning the treatment tip adjacent the one or more septa. The method can also comprise delivering energy through the treatment tip to the one or more septa so as to heat said one or more septa. In some aspects, heating a portion of the skin tissue can comprise applying at least one of optical energy, electrical energy, RF energy, and ultrasound energy to the skin tissue.
• In one aspect, the invention relates to a device for treating cellulite that comprises a vacuum source configured to generate a negative pressure. The device can also comprise a housing adapted to be placed in contact with a skin surface, the housing defining a cavity in fluid communication with the vacuum source through one or more passageways within the housing such that at least a portion of the skin tissue is drawn into the cavity when negative pressure generated by the source is applied to said cavity. The device also comprises an energy source configured to apply energy to said skin tissue disposed within the cavity so as to heat at least a portion of connective tissue to a temperature of at least about 50° C.
• In various embodiments, the connective tissue comprises one or more septa, and the negative pressure can be configured to apply a tensile force greater than about 0.1 N/cm²to said one or more septa. For example, the tensile force per unit area can be greater that about 1 N/cm².
• In various embodiments, the energy source can be configured to deliver at least one of optical energy, electrical energy, RF energy, and ultrasound energy. In one aspect, the energy source can be configured to deliver optical energy having at least one wavelength in a range of about 600 nm to about 2700 nm, for example, at least one wavelength in a range of about 910 nm to about 930 nm (e.g., 915 nm).
• In one aspect, the device can also comprise a fluid flow pathway extending through the housing and in fluid communication with the vacuum source and the cavity. The fluid flow pathway can contain a liquid that is pumped by the vacuum source so as to generate the negative pressure in the cavity.
• In one aspect, a device for treating cellulite is disclosed herein that includes a housing adapted to be placed in contact with a skin surface. The housing defines a cavity. A fluid flow pathway extends through the housing and is in fluid communication with the cavity and a source for generating a negative pressure on a liquid contained within the fluid flow pathway so as to draw at least a portion of the skin tissue into the cavity when negative pressure generated by the source is applied to said cavity.
• In various embodiments, the fluid flow pathway can be in thermal contact with a cooling element. The cooling element can be configured to cool the liquid to a temperature in the range of about −5° C. to about 5° C., for example. In some embodiments, the fluid flow pathway can be in thermal contact with a heating element. The heat element can be configured to heat the liquid to a temperature in the range of about 35° C. to about 45° C., for example.
• The negative pressure on the liquid can be at a variety of pressures. By way of example, the negative pressure on the liquid can comprise a pressure in the range of from about −0.1 bar to about −0.5 bar. For example, the negative pressure on the liquid can comprise a pressure in the range of from about −0.2 bar to about −0.3 bar.
• In one aspect, the invention relates to a device for treating tissue that comprises an optical radiation source, and an optical fiber extending from a proximal end to a distal end and configured to emit from the distal end optical radiation generated by the radiation source. The device can also comprise a conductive heating element disposed at the distal end of the optical fiber, wherein the conductive heating element and the distal end of the optical fiber are disposed so as to define a cavity therebetween. The conductive heating element can be positioned relative to the fiber such that the conductive heating element is configured to receive optical radiation emitted from the distal end of the optical fiber so as to heat tissue in thermal contact with the conductive heating element.
• In some aspects, the conductive heating element can comprise a rod extending along a length of the optical fiber. In a related aspect, the distal end of the rod can be disposed relative to the distal end of the optical fiber so as to define a concave cutting surface. In various embodiments, the conductive heating element can comprise a sleeve coupled to the optical fiber. The sleeve can comprise a plurality of protrusions extending distally beyond the distal end of the optical fiber. In some embodiments, the protrusions can be configured to engage tissue therebetween. In one aspect, the device can be configured to be inserted through the skin. The device can have, for example, a diameter at its distal end in a range of from about 1 mm to about 3 mm. In some aspects, the device can also comprise a vibration element configured to vibrate at least one of the distal end of the optical fiber and the heating element.
• In one aspect, there is provided a device for improving the appearance of cellulite that comprises an optical radiation source; and an elongate probe extending from a proximal end to a distal end. The device also comprises an optical fiber coupled to the elongate probe and configured to emit from a distal end optical radiation generated by the radiation source. The distal end of the elongate probe can be configured to vibrate, for example, to ease the insertion of the probe through tissue. In some aspects, the distal end of the probe can be rounded. In various aspects, the distal end can vibrate in a range of from about 0.5 mm to about 2 mm at a frequency in a range from about 10 Hz to about 120 Hz.
DESCRIPTION OF THE DRAWINGS
• Further understanding of various aspects of the invention can be obtained by reference to the following description in conjunction with the associated drawings, which are described briefly below.
• FIG. 1 is a schematic view of the inside of a subject's body in a region of cellulite; the schematic view depicts the subcutaneous tissue, which is located between the skin (e.g., the epidermis and dermis) and muscle and bone. The subcutaneous tissue includes a relatively thin layer (e.g., a single layer) of subcutaneous fat.
• FIG. 2 is a schematic view of the inside of a patient's body in a region of cellulite; the schematic view depicting the subcutaneous tissue, which is located between the skin (e.g., the epidermis and dermis) and muscle and bone. The subcutaneous tissue includes a relatively thick layer (e.g., a multiple layers) of subcutaneous fat.
• FIG. 3 shows a diagram of the generalized relationship of force applied to connective tissue on the x axis and the elongation of the connective tissue in response to the applied force on the y axis.
• FIG. 4A depicts an experimental set-up for determining exemplary treatment parameters including the relationship between temperature of the tissue and the load applied.
• FIG. 4B presents the results obtained by using the experimental set-up depicted inFIG. 4A.
• FIG. 5 schematically depicts an exemplary embodiment of a device and method for treating and/or reducing the appearance of cellulite.
• FIG. 6 presents the effect of the application of various wavelengths of optical radiation on the surface temperature of the skin.
• FIG. 7 depicts another exemplary embodiment of a device and method for treating and/or reducing the appearance of cellulite.
• FIG. 8A depicts another exemplary embodiment of a device and method for treating and/or reducing the appearance of cellulite.
• FIG. 8B depicts another exemplary embodiment of a device and method for treating and/or reducing the appearance of cellulite.
• FIG. 9 depicts another exemplary embodiment of a device and method for treating and/or reducing the appearance of cellulite.
• FIG. 10 depicts another exemplary embodiment of a device and method for treating and/or reducing the appearance of cellulite.
• FIG. 11A depicts an exemplary contour of the contact plate ofFIG. 10.
• FIG. 11B depicts another exemplary contour of the contact plate ofFIG. 10.
• FIG. 12 depicts an exemplary embodiment of a device and method for treating and/or reducing the appearance of cellulite.
• FIG. 13 depicts an exemplary embodiment of a treatment probe that can be inserted into skin tissue for treating and/or reducing the appearance of cellulite.
• FIG. 14 depicts another exemplary embodiment of a treatment probe that can be inserted into skin tissue for treating and/or reducing the appearance of cellulite.
• FIG. 15 depicts another exemplary embodiment of a treatment probe that can be inserted into skin tissue for treating and/or reducing the appearance of cellulite.
DETAILED DESCRIPTION
• Anatomically, the cutaneous formation of cellulite is often due to fibrosis of the connective tissues present in the dermis and/or in the subcutaneous tissue. Connective tissue of the reticular dermis is connected to the deep fascia by fibrous septum from adipose or fat tissue. Subcutaneous fat lobules are separated from each other by fibrous septum (i.e., septa), which are generally relatively thin and usually rigid strands of connective tissue. The fibrous septa cross the fatty layer and connect the dermis to the underlying fascia tissue. The septa stabilize the subcutis and divide the fat tissue. Shortening of these septa due, for example, to fibrosis, causes retraction of the septa which in turn causes the depressions in the skin that are recognized as cellulite.
• Thus, cellulite appears in the subcutaneous level of skin tissue where fat cells are arranged in chambers of fat tissue that are surrounded by bands of connective tissue called septae and/or fascia. Under certain conditions, for example, as water is retained, fat cells held within the perimeters of these fat tissue chambers expand and stretch the connective tissue. In some situations, the septa tissue is physiologically short and/or the septa tissue contracts and hardens holding the skin at a non-flexible length, while the surrounding tissue continues to expand with weight, or water gain, which results in areas of the skin being held down while other sections bulge outward, resulting in the lumpy, “cottage-cheese” appearance recognized as cellulite.
• Referring now toFIG. 1, inside a subject'sbody1000, betweenmuscle1009 anddermis1008 is connective tissue called fiber stents orsepta1007. In some embodiments,bone1013 is adjacent tomuscle1009.Fiber septa1007 are bundles of connective tissue fibers that are held between thedermis1008 and themuscle1009. As discussed herein, fiber stents include soft tissue such as fibrous septa, which is composed of collagen fiber material similar to what is found in the dermis tissue, vascular tissue, and lymph tissue.Septa1007 align and connect themuscle1009 and thedermis1008 to one another. Thesepta1007 traverse through at least a portion offat tissue1006 inside the subject's body1002. In some individuals, generally in females, when a volume offat tissue1006 between septa1007 (e.g., between one septae1007aand anotherseptae1007b) is over a threshold amount it creates an uneven, dimpled, and/or bumpy appearance on the external portion of thebody1004 and thesedimples1003 and/or bumps in the tissue are recognized as cellulite appearance. Cellulite appears due to the interaction of the existingfat1006 with thesepta1007. A person with low fat could have cellulite because they havetight septa1007. In some instances, cutting thesepta1007 in the region of thedimples1003, e.g., in the areas between the bumps, with a knife to relieve the stress caused by the volume offat tissue1006 between septa1007 (e.g.,adjacent septa1007aand1007b) provides relief to the stress on the skin tissue that previously resulted in a dimpled and/or bumpy appearance. Cutting thesepta1007 can result in a flattening of the skin that was formerly bumpy in the region of thesepta1007. However, cutting thesepta1007 inside the skin is dangerous because it risks unintended consequences including nerve damage and muscle damage, for example.
• Cellulite is generally a problem for females but is less common in males. In females thesepta1007 between thedermis1008 and themuscle1009 are substantially vertical relative to the plane of thedermis1008 and/or the plane of themuscle1009. Generally, the fibrous septa in women are orientated in a direction perpendicular to the cutaneous surface. In contrast, males have septa between the dermis and the muscle that are shifted to the side at an angle relative to the substantially vertical direction of the septa found in females. In males the septa have an angled or criss-cross pattern that does not feature the perpendicular direction relative to the cutaneous surface. Without being bound to a single theory, it is believed that the shifted angle of septa found in males provides a level of “give” such that changes in fat quantity inside a male's body do not result in the cellulite appearance. In addition, subcutaneous fat is divided into lobules and in women the fat lobules are relatively larger and more rectangular when compared with the fat lobules found in men. The substantiallyvertical septa1007 found in females does not afford the “give” provided by the criss-cross pattern in males, further, the relatively larger size of fat lobules in women contribute to the cellulite appearance problem being more common for females than for males.
• Thus, the substantially vertically orientedsepta1007 in females are primarily responsible for the typical orange peel/bumpy appearance that is recognized as cellulite.FIG. 1 depicts body areas having relatively thin subcutaneous fat (e.g., a single layer of fat tissue1006) such as, for example, the under arms and the abdomen (i.e., the belly). The relative thickness or thinness of a body area will vary depending on individual anatomy.
• FIG. 2 shows a patient'sbody3000, and more specifically, a body area having a relatively thick layer of subcutaneous fat made up of multiple chambers of fat tissue (e.g.,3006a,3006b,3006c,3006d,3006e, and30060 some of which are stacked on one another (e.g.,3006band3006e). Relatively thick layers of subcutaneous fat that are made up of multiple chambers of fat tissue can include, for example, the buttocks and/or the thighs. The inside of a patient'sbody3000 under theepidermis3010, betweenmuscle3009 anddermis3008 includes connective tissues including septa3007 (also referred to as fiber stents) andfascia3011. In some embodiments body areas that include cellulite havebone3013 adjacent tomuscle3009.
• Generally, a woman's anatomy features connective tissue including one or more vertical septa3007 that are substantially vertical relative to at least one of thefascia3011, themuscle3009, and/or the skin (e.g., theepidermis3010 and the dermis3008). The septa3007 traverse through at least a portion offat tissue3006 inside the subject's body3002. Referring still toFIG. 2, in body areas having a relatively thick layer of subcutaneous fat, multiple layers offat tissue3006 are stacked between, above and below connective tissue. More specifically, inside the subject's body3002 in the region of some body areas having a relatively thick region of subcutaneous fat, thefat tissue3006 is stacked between substantially vertical septa3007 and above and below substantiallyhorizontal fascia3011. In some embodiments, thefat tissue3006 chambers (e.g.,3006a,3006b,3006c,3006d,3006e, and30060 have an irregular pattern.
• The connective tissue including the septa3007 and thefascia3011 align and connect themuscle3009 and thedermis3008 to one another. In some subjects, generally in females, when a volume offat tissue3006 between connective tissue3007 (e.g., between onesepta3007band another septa (e.g.,3007aand3007d) and fascia3011) is over a threshold amount it creates an uneven, dimpled, and/or bumpy appearance on the external portion of thebody3004 and thesedimples3003 and/or bumps in the tissue are recognized as cellulite appearance. Cellulite appears due to the interaction of the existingfat3006 with the connective tissue (e.g., the septa3007 and/or the fascia3011). Without being bound to any single theory it is believed that in some embodiments, thefascia3011 connects to the septa3007 and acts as an anchor that holds the septa3007 in a position that increases the pull of the septa3007 against thedermis3008 and/or theepidermis3010 and this tension/pull contributes to the cellulite appearance provided by thedimples3003.
• FIG. 3 is a diagram that shows the generalized relationship of force applied to connective tissue and the elongation of the connective tissue in response to the applied force. The force applied to connective tissue (e.g., septa and/or fascia) is shown on the x axis (force shown as F in arbitrary units (au)) and the y axis shows the elongation of the connective tissue (e.g., septa and/or fascia) as ΔL (in arbitrary units). The x axis also shows F_mwhich is the elasticity limit of the connective tissue being treated. The elasticity limit is the maximum force which provides a change in length ΔL of the connective tissue that is directly proportional to the applied force F. The x axis also shows F_m, which is the maximum force applied during a given elongation treatment. The y axis shows ΔLo, which is the lasting elongation after releasing the force F applied to the connective tissue. Lasting elongation includes elongation that lasts for several hours after treatment, e.g., two or more hours after treatment, and can include elongation that is substantially irreversible (i.e., elongation that is maintained and is substantially permanent) after treatment.
• As seen inFIG. 3, when the maximum force F_mis higher than the elasticity limit F_e1then elongation of the connective tissue becomes non-linear such that it responds to an applied force that is greater than F_e1in a non-linear manner. After releasing the applied force F the length of the connective tissue demonstrates hysteresis behavior (as described in greater detail in reference to FIG. 3A of U.S. Ser. No. 12/842,734, which is incorporated by reference herein), which results in the lasting elongation having the quantity depicted as ΔLo. The F_e1can be a function of the tissue temperature and the time of application of the temperature to tissue. By elevating tissue temperature, the F_e1may be lowered and the lasting elongation ΔLo can be achieved with a relatively lower Force than is required in the absence of an elevated temperature. Thus, by increasing the temperature of the connective tissue to be treated with a force F, the amount of force required to improve the length of (e.g., elongate) the connective tissue is reduced. In this way, negative side effects to the body area being treated including tearing, bruising and pain can be reduced and/or avoided.
• FIG. 4A depicts an experimental set-up for determining exemplary treatment parameters. As shown inFIG. 4A, a sample of porcine skin (e.g., the dermis and subcutaneous fat) can be used to determine treatment parameters. The fat of the tissue sample can be coupled to a mass to test the relationship between the tensile load applied to the sample and the temperature of the sample.
• FIG. 4B presents the results obtained for porcine skin by using the experimental set-up ofFIG. 4A. The plot ofFIG. 4B shows that the “tensile strength” of the samples (the mass in grams that the sample can withstand) substantially and drastically decreases at temperatures above about 50° C. The data presented herein shows that the amount of force needed to break the connective tissue can be substantially reduced when the skin tissue is at temperatures of at least about 50° C., or from about 50° C. to about 100° C., or from about 50° C. to about 70° C.
• The treatment parameters (e.g., the energy and tensile load applied to the tissue) are preferably selected to minimize, and preferably eliminate, undesired damage to the tissue, for example, bruising of the patient. Accordingly, methods and devices disclosed herein can be configured to improve the appearance of cellulite (e.g., by breaking fibrous septa), while preventing excessive or undesired tissue damage and/or bruising.
• The temperature of the skin tissue can be elevated in order to reduce the force necessary to break connective tissue and/or remodel the skin tissue using a variety of devices and methods in accord with the teachings herein. By way of example, energy can be delivered to the skin tissue invasively, for example via a probe inserted through an incision, or non-invasively, for example through the external application of energy. With reference now toFIG. 5, an exemplary embodiment of a device520 for non-invasively treating and/or improving the appearance of cellulite is shown. Though the device520 is depicted as delivering optical energy530 to heat at least a portion of theskin tissue500 through theskin surface504, it will be appreciated by a person skilled in the art that the device520 can instead or additionally be configured to deliver one or more of radiofrequency (RF) energy, ultrasonic energy, microwave energy, or thermal energy (e.g., via thermal conduction) through theskin surface504 in order to heat the subcutaneous tissue to temperatures at which the force of breaking the connective tissue is reduced. As shown inFIG. 5, thedevice500 can deliver optical energy530 to the subcutaneous fat506, for example, through theskin surface504 to heat thesepta507 attached to the lower portion of thedermis508. Anoptical window540, which can be made of a material (e.g., sapphire) having high thermal conductivity and a refractive index to aid in coupling the optical energy into theskin tissue500, can be placed in contact with theskin surface504. The optical energy530 applied through theoptical window540 can heat an entire region ofskin tissue500 in which the target tissue is located and/or preferentially heat a target tissue at depth. By way of example, optical energy530 that is selectively absorbed by theskin tissue500 below the level of the dermis510 (e.g., subcutaneous fat) can be applied to theskin surface504. In use, as the septa is heated by the optical energy to temperatures in a range from about 40° C. to about 65° C., the tension on thesepta507, which causes the dimple/cellulite appearance, can be sufficient to break thesepta507. As will be discussed in detail below, in various embodiments, additional tension can be applied to thesepta507 concurrent with or subsequent to heating to break thesepta507, for example, through the application of a vacuum.
• The optical energy530 can be generated by a variety of sources. For example, any of coherent, incoherent, continuous, and/or pulsed sources of optical energy can be used with the device520. In various embodiments, diode or solid state lasers and filtered arc lamps can be used to generate the optical energy. The optical sources can be contained within the device520, for example, or can be operatively coupled thereto. In some embodiments, optical radiation in a wavelength range of from about 0.8 microns to about 1.6 microns, preferably from about 910 to about 930 nm and/or from about 1200 nm to about 1220 nm, and in a power density range of from about 20 to about 7000 W/cm²can be generated by a source and pass through theoptical window540. In various embodiments, pulses of the optical energy can be applied to theskin tissue500 for time periods ranging from about 1 second to about 20 seconds. Optical radiation can be delivered in one beam or in multiple separated micro-beams (e.g., fractional micro-beams).
• Referring now toFIG. 6, experimental data resulting from the application of various wavelengths of optical radiation to skin tissue is shown. As shown inFIG. 6, the delivery of optical radiation to theskin tissue500 can raise the temperature of the skin tissue during and subsequent to irradiation by various light sources. By way of example,FIG. 6 demonstrates that the delivery of optical energy having a wavelength of 924 nm and at a power of 40 W can be effective to raise the temperature of the skin surface to about 50° C. within about one second. Likewise, the delivery of optical energy having a wavelength of 975 nm and at 40 W can be effective to raise the temperature of the skin surface to about 55° C. within about one second. After terminating the application of the radiation, the skin surface temperature can decrease at a rate depending on the rate of thermal conduction from tissue at depth. By way of example, the rapid cooling of the skin surface following the application of optical energy having a wavelength of 924 nm relative to that of skin surface following the application of optical energy having a wavelength of 975 nm indicates that the 924 nm optical energy provides deeper penetration into the skin tissue. The data also suggest that less energy is deposited immediately below the skin surface by optical radiation having a wavelength of 924 nm relative to that of optical energy having a wavelength of 975 nm.
• Though the wavelength of the optical radiation can be selected so as to target a tissue at depth (e.g., subcutaneous fat),FIG. 6 indicates that the temperature of the skin surface can be raised through thermal conduction from the targeted tissue. To reduce skin surface heating, which can reduce pain experienced by a patient undergoing treatment, contact cooling of the skin surface can be provided. With reference again toFIG. 5, the device520 can be configured to cool the surface of the skin before, during, or after the delivery of optical energy thereto. By way of example, theoptical window540 can be configured to remove heat from the surface of the skin. By way of example, theoptical window540 can be in thermal contact with a cooling element coupled to the device520. By way of non-limiting example, a thermoelectric Peltier cooler can be used to cool theoptical window540. Alternatively, theoptical window540 can include channels containing coolant. In various embodiments, the channels containing the coolant can thermally contact the edge of theoptical window540 so as not to obstruct viewing and/or delivery of optical energy530 therethrough. Theoptical window540 can be maintained at various temperatures to provide sufficient contact cooling of the skin surface. By way of example, theoptical window540 can be maintained at a temperature in a range of from about −5° C. to ambient temperature, preferably from about 0° C. to about 18° C., to maintain the temperature of the entire dermis and epidermis of the skin at temperatures between about 0° C. and 42° C. In various embodiments, optical energy530 can be delivered to theskin tissue500 prior to contact cooling, concurrent with contact cooling, and/or subsequent to contact cooling.
• In one aspect, methods for the noninvasive treatment of the appearance of cellulite can also include cyclically heating and cooling the skin tissue, or alternatively, simply cooling the skin tissue to remodel theskin tissue500 in accord with the teachings herein. By way of example, theoptical window540 can be operated as a cooling plate that can cool the skin tissue to a depth, and through which optical energy can be applied intermittently as discussed in U.S. Pat. No. 7,276,058, which is herein incorporated by reference in its entirety, and modified in accord with the teachings herein.
• Reference now is made toFIG. 7, which depicts an exemplary method and device for remodelling the skin. As shown inFIG. 7, adevice720 can be located adjacent the skin and a vacuum can be applied to acavity726 of thedevice720 when thedevice720 is placed in contact with theskin surface704. The vacuum can be effective to draw theskin tissue700 into thecavity726 and apply a tensile load on theskin tissue700. For example, the suction can be effective to provide a tensile load per unit area less than about 10 N/cm². In one aspect, the suction can provide a tensile force per unit area of between about 0.1 N/cm²to about 10 N/cm², and more preferably in a range of about 0.1 N/cm²to about 1 N/cm². In another aspect, the suction can provide a tensile force per unit area greater than about 0.1 N/cm². By way of example, the tensile force can be greater than about 1 N/cm², greater than about 2 N/cm², greater than about 5 N/cm², greater than about 5 N/cm², or greater than about 10 N/cm². In various embodiments, the tensile force can sufficient to stretch or break the connective tissue.
• After engaging theskin tissue700 within thecavity726, energy (e.g., optical energy730) can be applied to the skin tissue contained therein to heat theskin tissue700, and preferably, the subcutaneous skin tissue. By raising the temperature to a range of about 50° C. to about 100° C. (e.g., in a range of about 60° C. to about 80° C.), while applying the suction to theskin tissue700, subcutaneous connective tissue can be altered as otherwise discussed herein. By way of example, septa present in the subcutaneous tissue can be stretched and/or broken. Additionally or in the alternative, the application of energy to theskin tissue700 can be effective to remodel the structure of the skin, which can lead to thickening of the dermal layer, for example. In such a manner, thedevice720 can be effective to treat and/or reduce the appearance of cellulite using a non-invasive means. Though the method described above demonstrates the application ofoptical energy730, it should be appreciated that other forms of energy such as electrical energy, radiofrequency (RF) energy, and ultrasound energy can also be applied to the skin tissue in accord with the teachings herein.
• With reference now toFIG. 8A, another embodiment of a method and device for non-invasively treating and/or improving the appearance of cellulite is shown. As otherwise discussed herein, thedevice820 can be configured to provide a stretching force to theskin tissue800 while applying energy (e.g., optical energy830) thereto. As shown inFIG. 8, thedevice820 can include asuction cup822 having anopen end824 that can be applied to theskin surface804 such that a portion of theskin tissue800 can be positioned withincavity826 when a negative pressure is applied thereto. At least a portion of thesuction cup822 can be optically transparent, for exampleoptical window840, such that optical energy can be applied to theskin tissue800 contained within thecavity826. Thesuction cup822 can be coupled to a vacuum pump (not shown) that can be operated to draw air out of thecavity826 throughconduits828. By way of example, the vacuum pump can reduce the pressure in thecavity826 to a pressure in the range of from about 100 to about 500 Torr, preferably from about 200 to about 380 Torr when theopen end824 of thesuction cup822 is placed in contact with theskin surface804. This sub-atmospheric pressure can draw theskin tissue800 into thecavity826, thereby stretching thedermis808 andsepta807 that is attached thereto. As discussed elsewhere herein, by placing thedevice820 over a cellulite dimple and applying a negative pressure thereto before, during, and/or after delivery of energy to theskin tissue800, thesepta807 responsible for the cellulite dimple can be stretched and/or broken to treat and/or improve the appearance of cellulite. By way of example, one or more pulses of optical energy830 can be delivered to theskin tissue800 disposed within thecavity826 that can be sufficient to heat thesepta807 causing it to break. The optical energy830 can be generated by a variety of sources, as discussed otherwise herein. In various embodiments, a source832 (e.g., a diode or solid state laser, filtered arc lamp) can be used to generate the optical energy. Thesource832 can be contained within thedevice820, for example, or can be operatively coupled thereto (e.g., from a base unit).
• With reference now toFIG. 8B, another exemplary embodiment of a method and device for non-invasively treating and/or improving the appearance of cellulite is shown. Thedevice820′ is substantially similar to that described above in reference toFIG. 8A. For example, thedevice820′ can include asuction cup822′ having anopen end824′ that can be applied to theskin surface804′ such that a portion of theskin tissue800 can be positioned withincavity826′ when a negative pressure is applied thereto.Conduits828′, however, can be fluidly coupled to thecavity826′ throughpassageways828′ that extend through thesuction cup822′ around the perimeter of theoptical window840′. By positioning the passageways860′ adjacent or in proximity to theoptical window840′ (e.g., in an annular ring around the circumference of the window), application of a negative pressure to thecavity826′ can be effective to draw theskin tissue800′ into the cavity such that the skin surface can be in contact with theoptical window840′, for example, as shown by the dashed line. As such, optical radiation generated by the source and directed through theoptical window840′ can be optically coupled directly into theskin tissue800′, rather than being transmitted through thecavity826′. As will be appreciated by a person skilled in the art, the optical window can comprise a material with a similar refractive index to that of skin to further aid in optically coupling the radiation into the skin.
• With reference now toFIG. 9, another exemplary embodiment of a method and device for non-invasively treating and/or improving the appearance of cellulite is shown. Thedevice920 is similar to that ofFIG. 8A. However, whereas theconduits828 can be fluidly coupled to a vacuum source operable to evacuate gas from within thecavity826 to draw theskin tissue800 therein, a liquid can be pumped through thefluid flow pathway928 to apply a negative pressure to thecavity926 to draw theskin tissue900 within the cavity. As shown inFIG. 9, thefluid flow pathway928 can be associated, for example, with any of a pump930, a cooling element932, and/or a heating element (not shown). By way of example, the device for applying negative pressure to the liquid, such as a pump930 (e.g., piston), can be configured to apply a sufficient negative pressure to the liquid within the fluid withincavity926 to draw theskin tissue900 into thecavity926. For example, actuation of the pump930 can be effective to apply a negative pressure to the liquid in thecavity926, e.g., to apply a pressure in the range from about −0.1 bar to about −0.5 bar, thereby drawing thetissue900 into thecavity926. In some aspects, actuation of the pump930 can be effective to apply a pressure in the range from about −0.2 bar to about −0.3 bar. As will be appreciated by a person skilled in the art, one or more valves can be provided to control the flow of fluid through the fluid flow pathway and/or into and out of thecavity926. It was unexpectedly discovered that, in accord with various aspects of the methods and systems disclosed herein, sufficient suction could be generated by applying a negative pressure to a liquid contained within thecavity926 to draw theskin tissue900 into thecavity926. Further, as will be discussed in detail below, the use of a cooling liquid in the flowing fluid pathway was found to be efficient in regulating the temperature (e.g. cooling) of the tissue. Without being bound by any particular theory, it is believed that the application of suction to the tissue within the cavity can promote increased blood flow to the skin, which is cooled by the liquid in the cavity. As the cooled blood flows to deeper tissue, it can facilitate cooling of that deeper tissue. Hence, the combination of suction and cooling of the skin can advantageously provide efficient cooling of deep tissue. Such cooling can in some embodiments reduce, or eliminate, the sensation of pain, e.g., as energy, such as optical energy, is applied to the connective tissue.
• With continued reference toFIG. 9, in one aspect, the liquid supplied by thefluid flow pathway928 can be effective to cool or heat theskin tissue900. By way of example, a cooling or heating element924 (e.g., a heat exchanger, thermoelectric element such a Peltier cell, etc.) can be provided to cool and/or heat the fluid flowing through thefluid flow pathway928. In some aspects, the cooling or heating liquid can be pumped through the fluid flow pathway into and out of thecavity926 at temperatures in the range of from about −5° C. to about 5° C. or from about 35° C. to about 45° C., respectively, As will be appreciated by a person skilled in the art, one or more auxiliary pumps can also be associated with thefluid flow pathway928 to circulate the fluid contained therein, even under the increased pressure provided by the pump930. In some embodiments, the heating and cooling fluid can be applied in a cyclical fashion so as to cyclically heat and cool theskin tissue900 in the area of the dimple.
• In various embodiments, after a period of cooling and/or heating, for example in the range of from about 10 minutes to about 45 minutes, one or more pulses of optical radiation can be delivered to theskin tissue900 to further heat thesepta907, thereby causing them to stretch and/or break. As described above, the optical energy can have a wavelength in a range of from about 0.8 microns to about 1.6 microns, preferably from about 910 to about 930 nm and/or from about 1200 to about 1220 nm, and a power density in a range of from about 20 to about 7000 W/cm². In various embodiments, pulse(s) of the optical energy930 can be applied to theskin tissue900 for a time duration ranging from about 1 second to about 20 seconds.
• In some embodiments, cooling and/or heating fluid can be applied in a cyclical fashion so as to cyclically heat and cool the skin tissue900 (e.g., fat cells) in the area of the dimple. Additionally, application of a cooling fluid can be alternated with heating of theskin tissue900 through the delivery of optical energy930. While heating or cooling alone can be useful for many treatments, heating and cooling applied intermittently to the skin surface (e.g., contrast therapy) can provide beneficial effects in reducing subcutaneous fat deposits and/or treating or improving the appearance of cellulite, as generally described in detail in U.S. Pat. No. 7,276,058, which is herein incorporated by reference in its entirety, and modified in accord with the teachings herein.
• Referring now toFIG. 10, an embodiment of a device and method for the noninvasive treatment of the appearance of cellulite is shown. As otherwise discussed herein, the device1020 can provide stretching of the skin tissue1000 (and its underlying connective tissue including thedermis1008 and septa1007). By way of example, acontact plate1040 having a contoured skin-contactingsurface1042 can be placed in contact with theskin surface1004. Thecontact plate1040 can have a variety of configurations to provide a contoured skin-contactingsurface1042. By way of example, theprotuberances1044 of thecontact plate1040 can provide compression and stretching of theskin1000. With reference now toFIGS. 11A and 11B, which depict exemplary embodiments of a contact plate having the cross-section depicted inFIG. 10 (along the dotted lines ofFIGS. 11A and 11B), the skin-contactingsurface1042 of thecontact plate1040 can include multiple grooves1046 (e.g., a sinusoidal groove pattern as shown inFIG. 11A) or a plurality of separated dimples1048 (e.g., an array of dimples as shown inFIG. 11B).
• As discussed otherwise herein, sub-atmospheric pressure can be applied throughports1048 in thecontact plate1040 to draw the skin into the contact plate's recesses1026 disposed between theprotuberances1044. By way of example, a vacuum supply (not shown) can be operatively coupled to the ports1028 to reduce the pressure in the recesses1026 to a pressure in the range of from about 100 to about 500 Torr, preferably from about 200 to about 380 Torr. Likewise, thecontact plate1040 can be configured to provide contact cooling and/or heating of theskin tissue1000 as discussed above. For example,contact plate1040 can be cooled by inter-laced cooling lines or thermo-electric elements.
• In addition, optical radiation can be applied to theskin tissue1000 through thecontact plate1040. As shown inFIG. 10, for example, the optical energy can be delivered as discrete, spatially separated beams (e.g., micro-beams1030a-c). By way of example, each of themicro-beams1030a-ccan be delivered through thecontact plate1004 to theskin tissue1000 through aprotuberance1044 to heat the dermis and/or subcutaneous fat beneath theprotuberance1044 by photothermolysis. By virtue of themultiple micro-beams1030a-c, in some embodiments, thedermis1008, for example, can coagulate only the position which receives the micro-bean1030a-c, thereby creating a fractional pattern of coagulation. Accordingly, in some embodiments, the device1020 can provide fractional stretching, cooling, and irradiation of theskin tissue1000. As a result of the fractional coagulation of the skin tissue, the healing process of the fractionally-treated skin tissue, as discussed generally in U.S. Pat. No. 6,997,923, can be effective to thicken the dermis, thereby improving the appearance of cellulite.
• With reference now toFIG. 12, an exemplary embodiment of a device for treating and/or reducing the appearance of cellulite is shown. The device1220 can include a housing1222 (e.g., a handpiece) for contacting theskin surface1204. Thehousing1222 can define acavity1226 therein that is configured to receive and/or engage at least a portion ofskin tissue1200 including the tissue that underlies theskin surface1204. As depicted, theskin surface1204 overlays a subcutaneous fat layer having a substantiallyvertical septa1207 therethrough, a layer of fascia1211, another layer of subcutaneous fat having substantiallyvertical septa1207′ disposed therethrough, amuscular layer1209, and bone1213.
• Thehousing1222 can additionally include a passageway1228 that can connect thecavity1226 to a vacuum pump (not shown), such as an aspirator vacuum pump. One or more holes1248 can provide fluid communication between the passageway1228 and thecavity1226 such that activation of the vacuum pump can be effective to apply suction to at least a portion of askin surface1204 and underlying tissue to draw the tissue into thecavity1226. The suction of theskin tissue1200 can be effective to apply a tensile load on the skin tissue1100 and the associatedsepta1207 and/or1207′. In one aspect, the suction can be effective to provide a tensile load per unit area less than about 10 N/cm². In one aspect, the suction can provide a tensile force per unit area of between about 0.1 N/cm²to about 10 N/cm², and more preferably in a range of about 0.1 N/cm²to about 1 N/cm². In another aspect, the suction can provide a tensile force per unit area greater than about 0.1 N/cm². By way of example, the tensile force can be greater than about 1 N/cm², greater than about 2 N/cm², greater than about 5 N/cm², greater than about 5 N/cm², or greater than about 10 N/cm². In various embodiments, the tensile force can sufficient to stretch or break the connective tissue.
• As shown inFIG. 12, the device1220 can also include a treatment tip v50 that can be configured to heat a portion of theskin tissue1200 disposed within thecavity1226. By way of example, a sidewall of thecavity1226 can include an opening1227 that allows thetreatment tip1250 to be inserted into the tissue (e.g., via access provided by an incision) disposed within thecavity1226. Alternatively, as shown in phantom by thetreatment probe1250′, a sidewall of the cavity need not include an opening. Rather, thetreatment probe1250 can be inserted directly into the skin and can be positioned adjacent, for example, a target tissue under tensile force caused by the application of a vacuum, as discussed otherwise herein. At least a portion of thetreatment tip1250 can be positioned adjacent asepta1207 and energy can be applied to the tissue to cause localized heating thereof. As will be appreciated by a person skilled in the art, any mechanism for heating the tissue can be effective to heat at least a portion of the skin. By way of non-limiting example, the treatment tip1250 (e.g., an end of the tip1250) can be configured to apply optical energy (e.g., laser or other light emission), electrical energy (ohmic resistance), RF energy, microwave energy or ultrasound energy. By way of example, these energy sources can have a power level from about 1 watt to about 100 watts, or from about 10 watts to about 60 watts.
• In one embodiment, thetreatment tip1250 can be configured to heat a portion of the tissue to at least 50° C. For example, the tissue (e.g.,septa1207 and surrounding tissue as indicated by the dashed line) can be heated to a temperature in a range of about 50° C. to about 100° C. (e.g., in a range of about 50° C. to about 70° C.). Thetreatment tip1250 can be used, for example, to apply one or more pulses of optical energy to the tissue. The one or more pulses can have at least one wavelength in a range of between about 800 nm to about 11 microns. For example, the optical energy can have at least one wavelength in a range of 800 nm to about 3 microns, in a range of about 910 nm to about 930 nm, or about 915 nm. In some embodiments, optical energy can have at least one wavelength in the range of from about 0.8 microns to about 1.6 microns, preferably from about 910 to about 930 nm or from about 1200 to about 1220 nm. One or more of the pulses can also have a pulsewidth in a range of about 0.1 second to about 10 seconds. In some aspects, thetreatment tip1250 can provide a conduit for passage of an optical fiber so that the tip of the fiber can be positioned in proximity to the connective tissue under treatment for application of radiation thereto.
• In some aspects, at least a portion of theelement1222 can be transparent, for example, to allow a user to position the device over a desired area of the skin to be treated (e.g. a cellulite dimple). Thus, a user could mark a cellulite-mediated dimple, for example, and align theelement1222 over the mark on the skin surface (e.g., the cellulite dimple). Additionally, in one aspect, energy can be applied directly through a transparent portion of theelement1222. In one embodiment thetreatment tip1250 is a laser that includes an aiming beam. Because in this illustrative embodiment, at least a portion of theelement1222 is transparent, the user can visualize the location of thetreatment tip1250 by its aiming beam and its position relative to the marked cellulite-mediated dimple. In this way the user can ensure that the region of the tissue beneath the surface of the dimple (e.g., at least a portion of substantiallyvertical septa1207,1207′) is heated in the presence of vacuum.
• Referring still toFIG. 12 in a non-invasive embodiment, instead of using theinvasive treatment tip1250, an energy source (not shown) that is external to the skin may be employed to heat a portion of the tissue, as discussed above with reference toFIGS. 5,7, and8A. For example, the tissue (e.g.,septa1207 and surrounding tissue as indicated by the dashed line) can be heated to a temperature in a range of about 50° C. to about 100° C. (e.g., in a range of about 50° C. to about 70° C.) using a non-invasive means. Suitable energy sources employed during the heating step can include, for example, focused ultrasound. In one embodiment, the heating step includes applying energy to the portion of skin tissue through a surface of the skin using at least one of optical energy, electrical energy, radiofrequency (RF) energy, and ultrasound energy to the skin tissue.
• In an embodiment where at least a portion of theelement1222 is transparent the element can be made from, for example, a transparent resin. The element can be reusable, disposable (e.g., designed for a one-time use) or substantially long lasting. In one embodiment, thecavity1226 has a diameter measuring from about 0.5 inches to about 10 inches and has a depth of from about 0.5 inches to about 5 inches.
• Referring now toFIG. 13, an exemplary embodiment of atreatment probe1350 for treating and/or improving the appearance of cellulite is depicted. While thetreatment probe1350 can be used in conjunction with the device1220 as discussed above with reference to thetreatment tip1250 depicted inFIG. 12, thetreatment probe1350 can also be inserted directly into tissue to cut, for example, a septa connecting the dermis with underlying fascia. As shown inFIG. 13, thetreatment probe1350 can include a light-delivery fiber1352 that is configured to deliver optical energy from itsdistal tip1352d. The fiber1352 can be optically coupled to an optical energy source (not shown), for example, a diode laser or solid-state laser. In one aspect, the source can generate optical energy having at least one wavelength in the range of from about 900 to about 1300 nm, preferably from about 910 to about 930 nm, and can have a power from about 20 W to about 70 W. In some aspects, pulses can range from about 1 to about 3 seconds to deliver from about 20 to about 210 Joules of optical energy.
• Thetreatment probe1350 also includes arod1354 that extends at least partially along a length of the fiber1352. Therod1354 can be positioned relative to thedistal tip1352dof the fiber1352 such that it can receive at least a portion of the optical energy emitted by the fiber1352. Therod1354 is generally configured to be heated upon irradiation by the fiber1352 and can be formed from a variety of materials and can be rigid, semi-rigid, or flexible. By way of example, therod1354 can comprise metal. Though therod1354 is shown having a similar diameter to that of the fiber and extending along the entire length of the fiber1352, a person of skill in the art will appreciate that therod1354 can have various configurations that enable its use in atreatment probe1350 as discussed herein. By way of example, rather than extending along the entire length of the fiber1352, therod1354 may extend only along the distal end of the fiber1352.
• The distal ends of the fiber1352 androd1354 can be disposed relative to one another so as to define a substantially concave cutting surface1356 between the distal ends. In one aspect, optical energy (e.g., generated by a laser) that is emitted from thefiber tip1352dcan heat the distal end1354dof therod1354 to an elevated temperature, e.g., a temperature sufficient to cut and/or sever connective tissue. Additionally, optical energy emitted by fiber1352 can be effective to heat the septa1307 such that the force necessary to cut, sever, or tear the septa1307 is decreased relative to that required under normal physiologic temperatures.
• In use, thetreatment probe1350 can be inserted through a small incision in the skin and positioned at a target region (e.g. septa) located beneath the skin surface1304. By way of example, thetreatment probe1350 can be disposed beneath the dermis-hypodermis junction to engage a septa1307 extending between the fascia and the dermis. In one aspect, thetreatment probe1350 can be advanced so as to dispose the substantially concave cutting surface1356 adjacent a target tissue (e.g., septa1307). One or more pulses of optical energy generated by a source can be delivered through the fiber1352 and emitted at itsdistal tip1352d. The optical energy can be sufficient to heat the distal tip1354dof therod1354 as well as the septa1307 that is positioned in thermal contact therewith. For example, the optical energy and/or the heated distal end1354dof therod1354 can be effective to heat the septa1307 at or near the temperature of coagulation. Concurrent with or subsequent to heating, a force can be applied to break the septa. By way of example, thetreatment probe1350 can be advance towards the septa1307.
• With reference now toFIG. 14, another exemplary embodiment of a treatment probe in accord with various aspects of applicants' teachings is depicted. As shown inFIG. 14, the treatment end (e.g., the distal end) of the treatment probe1450 can include a light-delivery fiber1452 that can be optically coupled to an optical energy source and can be configured to deliver optical energy from its distal tip1452d. The distal tip1452dcan have a variety of configurations and can comprise a variety of materials through which the optical energy can be emitted. By way of non-limiting example, the distal tip can comprise sapphire or quartz. Though the distal tip1452dis depicted with a tapered configuration, it will be appreciated that the tip can have a variety of shapes, for example, flat, recessed, etc.
• The treatment probe1450 also includes asleeve1454 that removably of fixedly coupled to the distal end of thefiber1452. By way of example, thesleeve1454 can circumferentially surround the distal end of the fiber1453. It should be appreciated that thesleeve1454 can extend proximally along thefiber1452 for various lengths, for example, the entire length of thefiber1452 to a position outside the body when the treatment probe1450 is disposed therein. As shown inFIG. 14, thesleeve1454 can include one ormore protrusions1456 that extend distally from thesleeve1454. Theprotrusions1454 can extend at least partially around the distal-most end1452dof thefiber1452 and can have various lengths. By way of example, the distal-most ends of theprotrusions1354 can be substantially level with the distal-most end1452dof thefiber1452. Alternatively, the distal-most ends1456dcan extend beyond the distal-most end of thefiber1452. In various aspects, thesleeve1454 an/orprotrusions1456 can be positioned relative to the distal tip1452dof thefiber1452 such that it can receive at least a portion of the optical energy emitted by thefiber1452 and can be heated upon irradiation by thefiber1452. Thesleeve1454 can be formed from a variety of materials and can be rigid, semi-rigid, or flexible. By way of example, therod1454 can comprise a metal such as stainless steel. Additionally, theprotrusions1456 can be disposed relative to one another and the fiber so as to define a cavity1457 for receiving a target tissue (e.g., septa). In one aspect, optical energy (e.g., generated by a laser) that is emitted from the fiber tip1452dcan heat theprotrusions1456 to an elevated temperature, e.g., a temperature sufficient to cut and/or sever connective tissue. Additionally, optical energy emitted byfiber1452 can be effective to heat the target tissue within the cavity1457 such that the force necessary to cut, sever, or tear the tissue is decreased relative to that required under normal physiologic temperatures. In various aspects, the probes described herein (e.g., probe1450) can have a diameter at their distal end in a range from about 1 mm to about 3 mm.
• In use, the treatment probe1450 can be operated in a similar matter as discussed above with reference to thetreatment probe1350 depicted inFIG. 13. For example, the treatment probe1450 can be inserted through a small incision in the skin and positioned at a target region (e.g. septa) located beneath the skin surface. By way of example, the treatment probe1450 can be disposed beneath the dermis-hypodermis junction and can be advanced so as to dispose a target tissue (e.g., septa) between theprotrusions1456 extending distally from thesleeve1454. One or more pulses of optical energy generated by a source can be delivered through thefiber1452 and emitted at its distal tip1452d. The optical energy can be sufficient to heat thesleeve1454 and/or itsprotrusions1456 as well as the septa, for example, that is positioned in thermal contact therewith. The optical energy and/or thesleeve1454 and/or theprotrusions1456 can be effective to heat the septa at or near the temperature of coagulation. Concurrent with or subsequent to heating, a force can be applied to break the septa. By way of example, the treatment probe1450 can be advance towards the septa.
• With reference now toFIG. 15, atreatment probe1550 for treating and/or improving the appearance of cellulite through the targeted heating of thefascia1511 is depicted. Thetreatment probe1550 is configured to be inserted through the skin surface and can be advanced such that the distal tip1550dis disposed below the dermis-hypodermis junction. Theprobe1550 itself or a light-fiber coupled to or extending through thetreatment probe1550 can be configured to deliver optical energy from its distal tip1550ddirectly to the underlying superficial or deep fascia (such as Camper's fascia or Scarpa's fascia). The distal tip1550dcan have a variety of configurations to ease its movement through tissue. For example, the tip1550dcan be tapered so as to reduce frictional force. In one aspect, the distal-most end of thetreatment probe1550 can be rounded to prevent accidental damage. Additionally or in the alternative, in some embodiments, the distal tip1550dcan be configured to vibrate to reduce frictional forces experienced by the tip1550dand to ease motion through subcutaneous tissue such as fat1505 andsepta1507. A rounded distal tip1550dand vibration of the distal end of the treatment probe can reduce the risk of perforating thefascia1511 such that the tip can “ride” on thefascia1511 without penetrating therethrough.
• By way of example, theprobe1550 can be optically coupled to a source (not shown) such as a diode laser or solid-state laser that is configured to generate optical energy. In one aspect, the source can generate optical energy that can be applied to the target tissue (e.g., fascia1511) having at least one wavelength in the range of from about 900 to about 1300 nm, preferably from about 910 to about 975 nm, and can have a power from about 20 W to about 70 W. The source can be operated in continuous mode or in pulsed mode. In one aspect, the pulses can have a pulse width from about 0.1 to about 2 seconds at repetition rates from about 0.5 Hz to about 5 Hz.
• In use, as shown inFIG. 15, thetreatment probe1550 can be inserted through an incision in the tissue and can be guided through the subcutaneous spaces to thetarget fascia1511. Once the distal tip1550dcontacts thetarget fascia1511, for example, the source can be activated such that optical energy coupled into the probe1450 can be emitted from the distal tip1550d. The tip1550dcan be moved during laser emission to heat the target fascia to stimulate contraction and new collagen growth, as otherwise discussed herein. In one aspect, if the user encounters resistance, for example, vibration can be activated to ease the motion of the distal tip1550dthrough the tissue. In one aspect, the amplitudes of vibration of the distal tip1550dcan range from about 0.5 to about 2 mm at frequencies from about 10 to about 120 Hz.
• Though thetreatment probe1550 ofFIG. 15 is depicted as being inserted directly through the skin, one of skill in the art will appreciate that the treatment probe can also be inserted into the skin through a device configured to apply vacuum to the skin, as discussed above with reference toFIG. 12.
• Though the devices discussed above are primarily described in their use for heating fascia, septa, or other subcutaneous tissue, it should be appreciated that these devices and methods can be applied to various portions of the skin for the treatment or improvement in the appearance of the skin. By way of example, a relatively thin dermal layer can also cause the appearance of cellulite. The devices and techniques described above can be modified to treat the appearance of cellulite through the thickening of the dermis, for example. As such, the application of energy to the dermal layer using the methods and devices described herein can be effective to stimulate new collagen growth and a thickening of the dermis.

Claims (44)

1. A method for improving the appearance of cellulite, comprising:

heating a portion of connective tissue to a temperature of at least about 50° C.,

applying a tensile force to the heated connective tissue.

2. The method ofclaim 1, wherein said tensile force per unit area is greater than about 0.1 N/cm².

3. The method ofclaim 1, wherein said tensile force per unit area is greater than about 1 N/cm².

4. The method ofclaim 1, wherein the tensile force is sufficient to stretch the connective tissue.

5. The method ofclaim 1, wherein the tensile force is sufficient to break the connective tissue.

6. The method ofclaim 1, wherein said heating step comprises applying energy to the portion of connective tissue through a skin surface.

7. The method ofclaim 6, wherein said heating step comprises applying at least one of optical energy, electrical energy, RF energy, and ultrasound energy to the connective tissue.

8. The method ofclaim 7, wherein said heating step comprises applying optical energy having at least one wavelength in a range of about 600 nm to about 2700 nm to the connective tissue.

9. The method ofclaim 8, wherein said optical energy has at least one wavelength in a range of about 910 nm to about 930 nm.

10. The method ofclaim 8, wherein said optical energy has a wavelength of about 915 nm.

11. The method ofclaim 8, wherein said optical energy comprises a plurality of pulses having a pulsewidth in a range of about 0.1 second to about 10 seconds.

12. The method ofclaim 8, wherein said optical energy is produced by a laser.

13. The method ofclaim 1, wherein said heating step comprises delivering a treatment tip through a skin surface to a location adjacent one or more septa, wherein said treatment tip is configured to deliver at least one of optical energy, electrical energy, RF energy, and ultrasound energy to the septa.

14. The method ofclaim 13, wherein said heating step comprises applying optical energy having at least one wavelength in a range of about 600 nm to about 2700 nm to the connective tissue.

15. The method ofclaim 14, wherein said optical energy has at least one wavelength in a range of about 910 nm to about 930 nm.

16. The method ofclaim 14, wherein said optical energy comprises a plurality of pulses having a pulsewidth in a range of about 0.1 second to about 10 seconds.

17. The method ofclaim 1, wherein said connective tissue comprises one or more septa and wherein said tensile is sufficient to break at least a portion of said one or more septa in said heated connective tissue.

18. The method ofclaim 1, wherein said connective tissue comprises one or more septa comprising collagenous fibers and blood vessels associated therewith, wherein said tensile force is sufficient to break at least one or more collagenous fibers within the one or more septa.

19. The method ofclaim 1, wherein said tensile force is exerted on the connective tissue by applying suction to a skin surface.

20. The method ofclaim 19, wherein applying suction to the skin surface comprises disposing near the skin surface an element having a cavity formed therein for receiving a portion of skin tissue, said element having one or more passageways for applying an evacuative force to the cavity.

21. The method ofclaim 1, wherein said tensile force is applied to the connective tissue at least one of during and after said heating step.

22. The method ofclaim 1, wherein the portion of connective tissue is heated to a temperature in a range of about 50° C. to about 100° C.

23. The method ofclaim 1, wherein the portion of connective tissue is heated to a temperature in a range of about 50° C. to about 70° C.

24. A method for improving the appearance of cellulite, comprising:

positioning an element having a cavity formed therein adjacent skin tissue having a cellulite-mediated dimple, said element having one or more passageways for applying an evacuative force to the cavity,

activating a vacuum source so as to apply the evacuative force to draw a portion of the skin tissue into the cavity, the suction being effective to apply a tensile force to one or more septa within the skin, and

heating a portion of the skin tissue to a temperature of at least about 50° C.

25. The method ofclaim 24, further comprising:

inserting a treatment tip into the skin tissue,

positioning the treatment tip adjacent said one or more septa, and

delivering energy through the treatment tip to said one or more septa so as to heat said one or more septa.

26. The method ofclaim 24, wherein heating a portion of the skin tissue comprises applying at least one of optical energy, electrical energy, RF energy, and ultrasound energy to the skin tissue.

27. A device for treating cellulite, comprising:

a vacuum source configured to generate a negative pressure;

a housing adapted to be placed in contact with a skin surface, the housing defining a cavity in fluid communication with the vacuum source through one or more passageways within the housing such that at least a portion of the skin tissue is drawn into the cavity when negative pressure generated by the source is applied to said cavity; and

an energy source configured to apply energy to said skin tissue disposed within the cavity so as to heat at least a portion of connective tissue to a temperature of at least about 50° C.

28. The device ofclaim 27, wherein the connective tissue comprises one or more septa, and wherein the negative pressure is configured to apply a tensile force greater than about 0.1 N/cm²to said one or more septa.

29. The device ofclaim 27, wherein the energy source is configured to deliver at least one of optical energy, electrical energy, RF energy, and ultrasound energy.

30. The device ofclaim 27, wherein the energy source is configured to deliver optical energy having at least one wavelength in a range of about 600 nm to about 2700 nm.

31. The device ofclaim 30, wherein the optical energy has at least one wavelength in a range of about 910 nm to about 930 nm.

32. The device ofclaim 27, further comprising a fluid flow pathway extending through the housing and in fluid communication with the vacuum source and the cavity, the fluid flow pathway containing a liquid that is pumped by the vacuum source so as to generate said negative pressure in the cavity.

33. A device for treating cellulite, comprising:

a housing adapted to be placed in contact with a skin surface, the housing defining a cavity;

a fluid flow pathway extending through the housing and in fluid communication with the cavity and a source for generating a negative pressure on a liquid contained within said fluid flow pathway so as to draw at least a portion of the skin tissue into the cavity when negative pressure generated by the source is applied to said cavity.

34. The device ofclaim 33, wherein the fluid flow pathway is in thermal contact with a cooling element.

35. The device ofclaim 34, wherein the cooling element is configured to cool the liquid to a temperature in the range of about −5° C. to about 5° C.

36. The device ofclaim 33, wherein the fluid flow pathway is in thermal contact with a heating element.

37. The device ofclaim 36, wherein the heating element is configured to heat the liquid to a temperature in the range of about 35° C. to about 45° C.

38. The device ofclaim 33, wherein the negative pressure on the liquid comprises a pressure in the range of from about −0.1 bar to about −0.5 bar.

39. The device ofclaim 38, wherein the negative pressure on the liquid comprises a pressure in the range of from about −0.2 bar to about −0.3 bar.

40. A device for treating cellulite, comprising:

an optical radiation source;

an optical fiber extending from a proximal end to a distal end and configured to emit from the distal end optical radiation generated by the radiation source at the proximal end; and

a conductive heating element disposed at the distal end of the optical fiber, wherein the conductive heating element and the distal end of the optical fiber are disposed so as to define a cavity therebetween,

wherein the conductive heating element is positioned relative to the fiber such that the heating element is configured to receive optical radiation emitted from the distal end of the optical fiber so as to increase heat tissue in thermal contact with the conductive heating element.

41. The device ofclaim 40, wherein the conductive heating element comprises a rod extending along a length of the optical fiber,

a distal end of the rod being disposed relative to the distal end of the optical fiber so as to define a concave cutting surface.

42. The device ofclaim 40, wherein the conductive heating element comprises a sleeve coupled to the optical fiber.

43. The device ofclaim 42, wherein the sleeve comprises a plurality of protrusions extending distally beyond the distal end of the optical fiber,

the protrusions being configured to engage tissue therebetween.

44. A device for improving the appearance of cellulite, comprising:

an optical radiation source;

an elongate probe extending from a proximal end to a distal end; and

an optical fiber coupled to the elongate probe and configured to emit from a distal end optical radiation generated by the radiation source at the proximal end; and

wherein the distal end of the elongate probe is configured to vibrate.

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